Validation of a computer version of the patient-administered Danish prostatic symptom score questionnaire.

OBJECTIVE: To validate a computer version of the Danish Prostatic Symptom Score (DAN-PSS) questionnaire and compare it with the paper version. MATERIAL AND METHODS: Ninety-three male patients (aged 25-87 years), referred to a department of urology for lower urinary tract symptoms (LUTS), filled in a personal computer (PC) version and a paper version of the DAN-PSS questionnaire. Subsequently they answered a questionnaire concerning their preferences and computer experience. RESULTS: A fair correlation between the total scores from the paper and PC versions was found. The differences were independent of both total score and age. In the PC version all LUTS questions were answered while 9.8% were left blank in the paper version. The sexual questions were answered by 71% of patients in the paper version and by 87.5% in the PC version. For the questions in the PC version a learning curve was observed in terms of the time taken to answer the questions. Previous computer experience did not influence answering time, difference in score between paper and PC versions or total score. Almost all patients preferred the PC version to the paper version. CONCLUSION: The PC scores are reasonably reliable judging by comparison with previously validated traditional paper scores. The PC questionnaire had a higher response rate and was preferred by the majority of patients.

[Treatment of phimosis with a steroid creme in boys]. / Behandling af phimosis hos drenge med steroidcreme.

UNLABELLED: The current treatment of phimosis in Denmark is surgical. Reports of success rates of 70-80% with topical steroids have prompted us to carry out the present study. METHODS: Parents of boys, who were referred because of phimosis, volunteered to participate in an open trial of topical clobetasol 0.05%, along with gentle mobilisation of the foreskin once daily for 4-6 weeks. Fifty-five boys completed the treatment. The results were recorded at clinical follow-up four and six weeks later, and a long-term follow-up was done by questionnaire sent after 9-11 months. RESULTS: At six weeks of treatment, 42 had a fully retractable foreskin, 11 a partially retractable foreskin, and two had unchanged phimosis. Ten patients had a circumcision or plasty. At long-term follow-up, 12 had a symptomatic recurrence. Four of these were given surgical treatment and eight had a repeat topical treatment, which was effective in six. The overall effect was independent of the degree of phimosis. Four patients with obvious sacrified foreskin failed. Twelve patients had agglutinations, which became apparent after the treatment for phimosis. We recorded no systemic and very few local side effects. The patients and parents found the treatment convenient and satisfactory. CONCLUSION: Topical clobetasol 0.05% once a day for 4-6 weeks can be recommended as primary treatment in phimosis in boys without scarification of the foreskin. The treatment may be repeated as necessary.

Lower urinary tract symptoms--a population survey using the Danish Prostatic Symptom Score (DAN-PSS) questionnaire.

OBJECTIVE: To describe voiding problems and the trouble they cause in a Danish population. Furthermore, to find symptoms specific for the ageing man, and thereby symptoms that might relate to an enlarged prostate. MATERIAL AND METHODS: The DAN-PSS questionnaire was mailed to a gender- and age-stratified random sample of 500 inhabitants in Herlev municipality. Prevalence of the symptoms and the trouble they cause were calculated and related to age and gender by the x2 test for trend and the chi2 test, respectively. RESULTS: The response rate was 73.6%. In total, 84.5% of the subjects had experienced at least one symptom within the previous fortnight. The various symptom prevalences ranged from 3.8-67.1%. Although many subjects experienced symptoms, they were not always bothered by them, and women were generally more bothered than men. Weak stream, hesitancy and dribbling occurred more often among men, whereas incontinence (stress, mixed) occurred more often among women. Nocturia and mixed incontinence increased in prevalence with increasing age among both men and women. Weak stream, incomplete emptying, stress and urge incontinence showed an age-related increase in prevalence among men, but not among women. These might therefore be symptoms of an enlarged prostate. CONCLUSION: Lower urinary tract symptoms occur with high prevalence in the background population, but they do not always cause trouble. Weak stream, incomplete emptying, stress and urge incontinence seem to be symptoms of an enlarged prostate.

[Validation of the patient-administered Danish Prostate Symptom Score Schedule]. / Validering af det patientadministrerede Danske Prostate Symptom Scoringsskema.

The DAN-PSS-1 system, a self-administered quality-of-life questionnaire comprising 12 questions related to voiding problems and the perceived bother of each individual symptom, was compared to other extensively used score systems and furthermore included in different clinical situations so as to validate the system. The system was internally consistent (alpha cr = 0.73), the median test-retest reliability of answers to each question was 83.5% (range 0-99.7%). A high degree of construct validity demonstrated in the correlation with the Madsen-Iversen score system (rs = 0.51) and with the patients' answers to questions about how bothersome their symptoms were (rs = 0.71). The discriminant validity of the DAN-PSS-1 was excellent with an area under the ROC curve of 0.94. Finally, the DAN-PSS-1 was sensitive to changes following intervention, with scores decreasing 100% after transurethral prostatectomy and 65% after four months of treatment with an alpha-blocker. The DAN-PSS-1 is reliable, valid and responsive, and therefore can be recommended for assessing the severity of symptoms among patients presenting with lower urinary tract complaints suggestive of BPH and during follow-up.

The in vitro cytotoxicity of urine from patients with interstitial cystitis.

Urine from patients with interstitial cystitis has been reported to be more cytotoxic than urine from healthy subjects when tested in vitro against cells from a normal urothelial cell line. The purpose of the present study was to develop a method to measure urinary cytotoxicity and so make it possible to estimate the toxicity of urine from interstitial cystitis patients. The study included 10 women with interstitial cystitis and 10 healthy controls. Urine specimens were obtained from both groups and urine cytotoxicity was measured by a modified 51Cr-release assay: A range of urine dilutions was added to suspensions of target cells with intracellular bound 51Cr, and cellular death was recorded by measuring the 51Cr-release from the target cells. The transitional cell bladder cell lines T24 and Hu609 and the erythroleukemia K562 cell line were used as target cells. There was no difference in urine cytotoxicity between interstitial cystitis patients and healthy controls. Urine cytotoxicity was increased by dilution in both groups.

The four-electrode impedance technique: a method for investigation of compliance in luminal organs.

A probe for measurement of related values of cross-sectional area (CA) and pressure has been developed to record characteristics of the walls in luminal organs. The aim of this study was to test the probe in vitro. CA was measured in the range 0.17 to 7.07 cm2 by means of the field gradient principle. Pressure was measured in the range 0 to 20 kPa (150 mmHg) by external transducers. After calibration both the pressure and the CA measuring system did measure the parameters adequately. The CA measuring system was dependent on the temperature and electrolyte concentration of the fluid, but was not affected by the size and form outside the excitation electrodes. The upper frequency limits for recordings of CA and pressure were 15.7 and 0.44 Hz, respectively. These in vitro results indicate that the tube assembly has characteristics sufficient for simultaneous measurement of CA and pressure in sphincter regions. These two variables can be used to describe mechanical wall properties such as compliance, hysteresis and creep.

Voiding difficulties after colposuspension.

To study subjective and objective changes of micturition after colposuspension, 80 patients were evaluated before and after surgery. It was found that colposuspension may introduce an element of urethral obstruction, which leads to a significant proportion of immediate as well as late voiding difficulties. Thus, 25% of the patients developed severe voiding difficulties in the immediate postoperative course. Low pressure voiding (Pdet less than 15 cm water) preoperatively was found to predispose significantly to immediate postoperative voiding difficulties. Another 20% developed late voiding difficulties. Increased urethral resistance preoperatively was found to predispose significantly to late postoperative voiding difficulties. Increased urethral rigidity is suggested as an underlying factor. Only four (5%) of the patients developed both immediate and late postoperative voiding difficulties. The detrusor pressure at maximum flow was found to be an unreliable parameter in assessing the true potential of the detrusor. It is emphasized that a thorough preoperative evaluation of both bladder and urethral function and the use of a proper surgical technique are required to avoid voiding difficulties after colposuspension.

Bladder distension in the management of detrusor instability.

In a 10-year period, 15 patients were treated with bladder distension because of urinary symptoms associated with detrusor instability. All patients had failed to respond to previous drug therapy. Ten patients had previously undergone surgical procedures for urinary incontinence, also without success. Five patients had repeated bladder distensions performed because of lack of improvement after the first procedure. Follow-up cystometry was performed in 14 cases. In all cases the instability was unchanged. Only one patient reported improvement in voiding symptoms. No complications were seen. With a success-rate of 6% (1 out of 15 patients) we do not recommend bladder distension with the present procedure as therapy for detrusor instability.

A new method for the investigation of the closure function of the resting female urethra.

The field-gradient principle has been used in the development of a probe for the recording of related values of cross-sectional area and pressure in the resting female urethra. The probe is used in a manner that allows pressure to be increased in steps of 10 cm. water, distending the urethra up to a cross-sectional area of 0.79 cm.2. Recordings are performed at 0.5 cm. steps throughout the urethra. The obtained parameters make possible a description of the closure function in terms of urethral rigidity, closure pressure of the noninstrumented urethra, capability of isometric and isotonic contraction, muscular function and power of the closure mechanism.

A probe for measurements of related values of cross-sectional area and pressure in the resting female urethra.

A probe for measurement of related values of cross sectional area (c.a.) and pressure in the resting female urethra has been developed. C.a. can be measured in the range 0.07 to 0.79 cm2 by means of the field gradient principle. Pressure is measured in the range 0 to 150 cm H2O. Pressure needed for inflation and deflation of the balloon ranges from +4 to -5 cm H2O with a hysteresis of 3 to 4 cm H2O. The probe is able to follow changes of the c.a. up to 0.7 cm2/sec. The method makes possible estimation of urethral stiffness/rigidity during distension of the balloon, estimation of the capability of contraction of the closure apparatus in terms of isometric and isotonic contraction, muscular work and power. Furthermore, hysteresis during inflation and deflation of the balloon can be described.

Electrophysiological investigation of hydronephrosis in children.

The hydrostatics and dynamics of the upper urinary tract were studied in 12 children with congenital hydronephrosis by means of intrapelvic pressure and bipolar electromyography leads from the pelvis and ureter. Studies were performed intraoperatively with the child under general anesthesia. Measurements were obtained during a baseline period of normal diuresis and during diuresis induced by furosemide. The baseline pressure in the hydronephrotic pelvis was within normal limits in most cases but a tendency toward an increased mean baseline pressure was observed in severe hydronephrosis when the cases were grouped according to the excretory urogram. During diuresis the average pressure increase in severe hydronephrosis was parallel to that in moderate hydronephrosis. The peristaltic pattern showed discoordination in pelvis conus transmission but usually preserved anterograde transmission from the conus down the ureter. The results seem to indicate a slight functional obstruction at the pelvioureteral junction. This obstruction leads to the observed alterations in peristalsis and to a slight elevation of the intrapelvic pressure in more severe cases.

Right ovarian vein syndrome. A case with pre- and peroperative electromyographic registration of ureteral activity.

Electrophysiological studies of ureteral function in a patient with right ovarian vein syndrome demonstrated intermittent antiperistalsis as reflected from pre-operative endoureteral activity recordings. The antiperistalsis was related to the patient intermittent right flank pain. Per-operative EMG and pressure measurements revealed that the antiperistalsis apparently arose from the area of obstruction and caused pressure waves of higher amplitude than those seen during normal anterograde peristaltic activity. After section of the vein, exclusively anterograde peristalsis was observed, and at 3 month follow-up, the patient was free of right side colics.

Complete sagittal septum of the bladder. A case report.

A case of complete sagittal septum of the bladder, successfully treated by resection of the septum is reported. The literature of this rare malformation is reviewed and alternate surgical procedures are discussed with regards to bladder function and continence.